| Radiant Soul Llc | |
|
845 W Center St Ste L200 Pocatello ID 83204-4205 | |
| (208) 943-8838 | |
| Not Available |
| Full Name | Radiant Soul Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 845 W Center St Ste L200, Pocatello, Idaho |
| Authorized Official Name and Position | Jennifer Beckstead (OWNER) |
| Authorized Official Contact | 2089438838 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant Soul Llc 845 W Center St Ste L200 Pocatello ID 83204-4205 Ph: (208) 943-8838 | Radiant Soul Llc 845 W Center St Ste L200 Pocatello ID 83204-4205 Ph: (208) 943-8838 |
| NPI Number | 1992676274 |
|---|---|
| Provider Enumeration Date | 09/17/2025 |
| Last Update Date | 09/17/2025 |
| Certification Date | 09/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992676274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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